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Predictors of long-term tumor control after stereotactic radiosurgery for Koos grade 4 vestibular schwannomas

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Abstract

Purpose

To evaluate the predictors of long-term tumor control following stereotactic radiosurgery (SRS) for Koos grade 4 vestibular schwannomas (VSs).

Methods

Overall, 203 sporadic VS patients with compression of the brainstem were treated with SRS. The median tumor volume was 6.7 cm3 (range, 2.0–28.9 cm3) and the median marginal dose was 12 Gy (range, 9–13.5 Gy).

Results

The median follow-up period was 152 months (range, 12–277 months). Tumor control (TC) rates at 3, 5, and 10 years were 89%, 85%, and 82%, respectively. Operation-free survival (OFS) rates at 3, 5, and 10 years were 92%, 85%, and 83%, respectively. Middle cerebellar peduncle (MCP) compression on pre-SRS magnetic resonance imaging scans was significant for both TC (p < 0.001, hazard ratio 1.332) and OFS (p < 0.001, hazard ratio 1.306). The 3-, 5-, and 10-year OFS rates were 98%, 94%, and 92% in the low-risk group (MCP compression < 9.8 mm and > 48 years old), and 58%, 25%, and 17% in high-risk group (MCP compression ≥ 9.8 mm and ≤ 48 years old), respectively. Ten patients (4.9%) developed delayed cyst-related complications. Eleven patients (5.4%) developed newly developed or worsened trigeminal neuralgia. No patient developed persistent facial palsy as an adverse radiation effect. A ventricular peritoneal shunt was required in six patients (3%) who developed hydrocephalus after SRS.

Conclusion

SRS is an acceptable treatment option in selected patients with Koos grade 4 VSs. Risk group classification based on patient age and MCP compression is useful in decision-making of Koos grade 4 VSs.

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Data availability

The dataset analyzed during the current study are included in this article and its supplementary file.

Code availability

SPSS Statistics for Windows, Version 26 (IBM Corporation, Armonk, NY, USA).

Abbreviations

ARE:

Adverse radiation effect

CI:

Confidence interval

GKRS:

Gamma Knife radiosurgery

GR:

Gardner-Robertson

HR:

Hazard ratio

MCP:

Middle cerebellar peduncle

MRI:

Magnetic resonance imaging

OFS:

Operation-free survival

SRS:

Stereotactic radiosurgery

TC:

Tumor control

VS:

Vestibular schwannoma

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Funding

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Authors and Affiliations

  1. Department of Neurosurgery, Gamma Knife Center, Komaki City Hospital, 1-20 Jobushi, Komaki, Aichi Prefecture, 485-8520, Japan

    Toshinori Hasegawa, Takenori Kato, Takehiro Naito, Takafumi Tanei, Kazuki Ishii, Eisuke Tsukamoto, Kou Okada, Risa Ito & Yuuta Kouketsu

Authors
  1. Toshinori Hasegawa
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  2. Takenori Kato
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  3. Takehiro Naito
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  4. Takafumi Tanei
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  5. Kazuki Ishii
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  6. Eisuke Tsukamoto
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  7. Kou Okada
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  8. Risa Ito
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  9. Yuuta Kouketsu
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Contributions

TH is a major contributor in writing the manuscript, analyzing and interpreting the data. The other authors contributed to data collection. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Toshinori Hasegawa.

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Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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This study was approved by our institutional review board. No.19104.

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All patients provided informed consents.

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Hasegawa, T., Kato, T., Naito, T. et al. Predictors of long-term tumor control after stereotactic radiosurgery for Koos grade 4 vestibular schwannomas. J Neurooncol 151, 145–156 (2021). https://doi.org/10.1007/s11060-020-03622-5

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  • DOI: https://doi.org/10.1007/s11060-020-03622-5

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